Previous literature suggests that increasing the number of patients screened in the emergency department (ED) for HIV infection leads to either an equivocal or decrease in the efficiency (proportion of positive tests). In January of 2015, our ED changed HIV testing strategies from external staff/convenience sampling to internal staff/routine offer. We assessed the effects of this change on our ED screening rates and testing efficiency.
From 2007 to 2014, the ED utilized an external staff/convenience sampling method (7,803 patients screened). From January 2015 to March 2016, the ED implemented an internal staff/routine offer strategy, allowing each patient to select whether they wish to be tested our not (2,064 patients screened). We determined the number of HIV tests performed and compared the proportion of positives tests (using Pearson’s Chi square test) by each testing strategy.
With implementation of the new testing strategy (external staff/convenience sampling to internal staff/routine offer), the number of tests done per month increased from 92 to 147. In addition, the proportion of total positive tests increased with the new testing strategy 2.77 fold from 3.5/1000 to 9.7/1000 (p < 0.001); the proportion of new positive tests increased 2.1 fold from 2.6/1000 to 5.3/1000 (P = 0.0458); and, the proportion of repeat positive tests increased 4.3 fold from 1/1000 to 4.3/1000 (p < 0.001).
Our experience in changing testing strategies from external staff/convenience sampling to internal staff/routine offer was associated with both an increase in number of tests performed as well as an increase in the proportion of positive tests. Because this was a ‘before and after’ study and this is a single site study, there was potential that other phenomena were driving the increase in HIV positivity rate. Nevertheless, further work might explore screening with internal staff/routine offer (while allowing patients to self-select) as an easy and efficient screening strategy.
A. Frisch, None
L. Sutton, None